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HomeMy WebLinkAbout762 Three Forks Dr - Applications/Single Family New - 12/20/2007BUILDING PERMITS RL INSPECTIONS DIVISION P.O. Box 580 • Fort Collins, CO 80522-0580 • Phone: 221-6760 www.fcgov.com/building Citv of Fort Collins BUILDING PERMIT APPLICATION APPLICATION NUMBER /J© /©(� — (/�" / APPLICATION DATE /� _�O ©� u Job Site Address 7/ 2 /f/6fe� , 5 Dya-, Unit # AIAW PROPERTYOWNER INFO: (All owner information is required - it is not optional) Phone # 970 - Last Name /d% U t�70i9S /I� ll II.IJr. L first Name j Middle Street Address /l � poft% GNQ.tq City Gy!/ll�Sd7- State ed Zip 905-.5t� Ji CONTRACTOR INFO: Company Name IA A C' r ,fit 1 ZLCcontractor Phone # 97/%- 39-7-131 Lic. Holder Name as,�rt/ a��G7 City of Fort Collins License #/-�S8 �� Supervisor Cert # fir- /l Mailing Address ,Uq nn/g?�, 11,4A4 City ll�//1ti�DJ' State �e1 Zip efdY d LEGAL INFO: fly Subdivision/PUD ��—CLeQg� Filing # Lot #�_ Block #_ Lot Sq Ft�`%I�� CONSTRUCTION INFO: Total Building Sq Ft (not including basement) //79:� Total Garage Sq Ft Residential Sq Ft _ Comm'I Sq Ft 0, # of Stories Bldg Height_ # Dwelling Units 4jjL.P_,- 1st Floor Sq Ft 2nd Floor Sq Ft /i/%yC% Unfinished Bsmt Sq Ft Finished Bsmt Sq Ft # of Bedrooms 3 # of. Full Baths '/< Baths Yz Baths _� # of Fireplaces Air Conditioning:( No Energy info: (Circle appropriate choice) 1. ComCheck 2. ResCheck w/Air Sealing 3. ResCheck w/Blower Door 4. E-Star w/Blower Door 5. Prescriptive w/Air Sealing ower Do City of Fort Collins Stock Plan # 16 / List appropriate option #s UTILITIES INFO: Water Tap Size Sewer Tap Size Metered: Yes or No Temp. Pedestal: Yes or No Type of Heat: ❑ Gas ❑ Electric Electric Main Breaker Size (Residential only): ❑ 150 Amp or Less ❑ 200 Amp ❑ Other Y Value of Construction (including /labor, /m/tri� material & profit) $ 65 � [/rZyQ. Aff . 9.J � rr� �/07. 2,0) Description of Work: / �� a , �'tL8 / l a?/ Gc/l�il � Dt� &axz' Contact Name & Phone # of JOBSITE SUPERVISOR: %QAAe/ 974°- 377- Subcontractor Info: Electrical /��fY4� //ems Mechanical /��i��o�rGJ�/�� %j%D�/. G% Plumbing�/�L(./��/fj'Cl��S Framer to l� �G/ ,Tifn . Roofing �� >5�t/Ait Concrete i emtN.c'lfzEUther //(,e Applicant: I hereby acknowledge that I have read this application and state that the above information is correct and agree to comply with all requirements contained herein and City o ort Collins ordinances and state laws regulating building construction. J- Applicant Signature ® Print Name 41114 Phone ,7d-,Tf7 13`7� Distribution: White - Office Yellow -Applicant Pink - WWW/Stormwater THIS APPLICATION EXPIRES 90 DAYS FROM APPLICATION DATE